FAST Scan

(Focused Assessment with Sonography for Trauma)

<Investigations>

<Index>

 

 

Features

-  Rapid, portable, non-invasive method of detecting haemoperitoneum, haemothoraces, pneumothoraces & pericardial effusions

-  Helps determine need for surgery, imaging or angiography

-  Considered an extension of examination for a trauma pt

 

Procedure

-  Trendelenburg position may assist visualisation of peritoneal fluid

-  RUQ (Morrisons view)

-  Probe at midaxillary line, 7-11th ICS

-  Demonstrates liver, kidney, diaphragm

-  Check Morrisons pouch

-  Slide probe inferiorly to check edge of liver

-  Slide probe superiorly to check pleural space

-  LUQ (Perisplenic view)

-  Probe at post. axillary line, 5-8th ICS

-  Demonstrates spleen, diaphragm +/- kidney

-  Check around spleen

-  Slide probe superiorly to check pleural space

-  Pelvic view

-  Probe immediately sup. to pubic symphysis

-  Difficult with empty bladder, perform prior to catheterisation

-  Demonstrates

-  Males: bladder, retrovesicular space

-  Females: bladder, uterus, pouch of Douglas

-  Check

-  Males: retrovesicular space for fluid

-  Females: pouch of Douglas for fluid

-  Cardiac view

-  Probe placed inf. to xiphoid & angled sup. &/or intercostals view

 

FAST - Cardiac - Subxiphoid probe

 

-  Demonstrates

-  Subxiphoid: liver, diaphragm, pericardial space & right ventricle

 

FAST - Cardiac view

 

-  Intercostal: right atrium, right ventricle, mitral valve

-  Check for fluid in pericardial space

-  Thoracic view

-  Probe placed midclaviclar line, 3-4th ICS

-  Uneffected side first

-  Demonstrates pleura sliding over ribs (sliding sign)

-  Check for absence of sliding sign

 

Results

- Anechoic regions (black) indicate fluid

-  Peritoneal free fluid: haemoperitoneum, ascities..

-  Morrisons pouch

 

Fast - Morrisons

 

-  Inferior edge of liver

-  Perisplenic

 

FAST - Spleen

 

-  Retrovesicular space (males)

-  Pouch of douglas (females)

 

FAST - Douglas

 

-  Pleural free fluid: pleural effusion, haemothorax..

-  Right or left pleural space sup. to diaphragm

-  Pericardial free fluid: haemopericardium, pericardial effusion

-  Pericardial space

-  Pneumothorax

-  Absence of sliding sign